Texas minorities face higher death rates from top causes

Heart disease, cancer, unintentional injuries, stroke and chronic lower respiratory diseases are the top five causes of death in Texas, mirroring national trends for the last decade.

However, studies have found significant differences in death rates from these causes based on race and ethnicity and whether people live in urban or rural areas.

Now, a study led by the Texas A&M University School of Public Health gives new insight into Texas-specific research on the five leading causes of death, focusing on how race, ethnicity and rural living were considered.

“Taking a deeper look is important because Texas is one of the most diverse states in terms of race, ethnicity and geography and has the nation’s largest rural population,” said Alva O. Ferdinand, DrPH, JD, who heads the school’s Department of Health Policy & Management and its Southwest Rural Health Research Center.

Supported by the Episcopal Health Foundation and published in the Journal of Racial and Ethnic Disparities, the study reviewed 403 peer-reviewed journal articles published from 1960 to 2022. The team analyzed how race, ethnicity and living in rural areas related to the five leading causes of death.

Their findings revealed that in Texas, African Americans often have higher death rates from heart disease, cancer and stroke. This group, along with American Indians/Alaskan Natives, are also disproportionately affected by unintentional injuries and chronic lower respiratory diseases. For Hispanics in Texas, cancer is the leading cause of death.

Those in rural areas—often poorer with less access to education and health care—faced higher death rates for the top five causes across all racial and ethnic groups. However, living in a rural area was not a significant predictor of mortality for any of the five leading causes of death in Texas.

“This was unexpected, given the state’s large rural population and number of people without health insurance,” Ferdinand said. “This could have resulted from a lack of a standard definition for rurality in the studies, which might have diluted the effects related to geography.”

The team’s review uncovered substantial gaps in understanding how race, ethnicity and rural living affect mortality.

Nearly half the studies reviewed focused on cancer, with the rest covering the other four leading causes of death—but only a handful considered people in rural areas.

“This emphasis likely is because of the surge of funding and attention cancer research has received, as well as the presence of MD Anderson Cancer Center in Houston,” Ferdinand said. “However, cancers that disproportionately affect rural and minority communities are underfunded.”

Additionally, the study highlighted insufficient attention to heart disease, stroke and respiratory illnesses during the study period, despite these conditions causing far more deaths than cancer in Texas.

The team found that stroke deaths in Texas were more strongly linked to Hispanic ethnicity, which differs from national findings. Deaths from unintentional injuries (such as vehicle crashes and falls) were also higher among Hispanic and Native American groups. Little was found about these injuries in Native American populations.

In addition, the team found no statistically significant associations for heart disease or cancer studies in Texas, in contrast to national studies.

The findings point to a need for more regular screenings, stronger disease management programs and better preventive care for at-risk populations, as well as more health care prevention and treatment services for those in underserved communities, Ferdinand said.

“There is a great need for more public health educators, nutritionists, community health workers, nurse practitioners, physicians’ assistants and physicians, among others, to provide support around the leading causes of death,” she said.

In addition, she said these findings could help policymakers and philanthropic organizations decide on where to focus Texas-specific research funding for health disparities in Texas.

“The bottom line,” Ferdinand said, “is that further research is needed to understand how factors such as race, ethnicity and urban or rural location affect health care equity.”

Other contributors from Texas A&M were graduate students Gogoal Falia and Emesomhi Eboreime and former graduate student Peter Harper, along with a colleague from the Episcopal Health Foundation.